The proposed project represents the next phase in a trajectory of research ultimately designed to eliminate racial disparities in the utilization of knee joint replacement - an effective treatment option for moderate to severe knee OA. The current study is designed to identify the modifiable, patient-level socio-cultural and clinical factors that may contribute to the underutilization of elective knee joint replacement by African- Americans (AA) with knee OA. Numerous studies utilizing a variety of clinical and administrative databases have documented the existence of racial/ethnic disparities in the utilization of joint replacement in OA management. For example, African-Americans are reported to be two to five times less likely than white patients to receive joint replacement for lower extremity osteoarthritis. Our research team conducted one of the first studies to explore the reasons why AA and white patients differ in their utilization of joint replacement. We found that, compared to white patients, AA patients are less willing to consider joint replacement even when clinically indicated and recommended by a physician. However, the specific sociocultural and clinical factors that impact patient willingness to consider joint replacement as a treatment option remain unknown. The short-term goa/of this proposal is to identify socio-cultural and clinical determinants of patient willingness. Patient willingness will be assessed in this proposal in two ways: (1) use of a single-item willingness question, 2) assessment of willingness-to-pay, a widely used health economic measure of contingent valuation. The long-term goal is to apply the knowledge gained from this proposal to develop and test a patient-centered intervention to eliminate racial disparity in the utilization of joint replacement. The central hypothesis of this proposal is that AA and white patients with knee OA differ in their willingness to undergo joint replacement because of socio-cultural and clinical factors that vary by race. The rationale is that by understanding the relationship between these socio-cultural and clinical factors and patient willingness to consider joint replacement as treatment option, we will be able to identify modifiable factors for intervention. Our proposal is innovative because it seeks to identify modifiable attitudinal-based sociocultural and clinical variables that shape patient willingness, which will pave the way for the development of a patient-centered intervention to reduce this disparity. The specific aims of this proposal are: 1) To examine differences between AA and white patients with knee OA in willingness to consider knee joint replacement. 2) To examine the relationship between socio-cultural factors and patient willingness to consider joint replacement. 3) To examine how demographic, socio-cultural, and clinical factors mediate the relationship between race and patient willingness. 4) To examine the relationship between patient willingness and referral to orthopedic care for knee OA (secondary aim).